Kris Oehlerts

Michael Stubbs

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A new era in health reform had a slow, bumpy and quiet start in South Dakota, with more action expected soon.

A computer glitch early Tuesday stopped some people trying to use the government’s new Internet marketplace. Other people needing health insurance went to work as usual and said they would think about it later. Even a protest against government intrusion in health care proved a modest endeavor in downtown Sioux Falls. Only two people showed up.

Agencies with specialists in place to help consumers reported a varying response on the first day of business.

“We’ve had a couple calls today. It’s kind of quiet, but it’s not surprising that it’s quiet,” said Diane Meland, a certified application counselor with All Points Health Services in Elk Point and Alcester. “This is a whole new thing. Given there’s a six-month period they can enroll, I think a lot of people might be a little hesitant to jump in. As more information comes out, then we’ll see an influx.”

The day marked the official nationwide start of enrollment for Americans to buy health coverage online in a marketplace, or insurance exchange, created by the Affordable Care Act of 2010. The law requires almost all Americans to carry insurance by the start of next year. Most South Dakotans do carry insurance already. The exchange is designed to reach those who don’t or those who wish to comparison shop to improve what they have.

While the marketplace opened Tuesday, anyone signing up by Dec. 15 will have coverage in effect by the Jan. 1 deadline specified under the law. A grace period allows anyone enrolled with coverage in place by the end of March to avoid paying a $95 tax as a penalty for not having coverage.

Activity was more brisk in Brookings, said Kim Jones, a navigator with the South Dakota Community Action Association. The federal website where consumers enroll temporarily was disabled at the start of the day.

“We’re having a healthy number of calls coming in. It’s a little bit challenging but not a surprise and kind of a good sign that there’s that much interest in it,” she said.

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Michael Stubbs, 52, a Sioux Falls construction worker, said he knew about the exchange and perhaps would consider using it.

He is single, has no family and no insurance.

“It’s tied in with so much politics, I don’t know what to do,” he said. “I’m about ready to buy some, but I probably will go with a local insurance agent so I feel like it’s somebody who is listening to me instead of somebody somewhere on a computer.”

Gregg Oehlerts, 52, a home inspector at work Tuesday in Sioux Falls, said he and his wife, Kris, pay $4,500 a year for insurance for them and their two sons under a policy that comes with a $10,000 per person deductible up to a maximum of $30,000. They might be in the market to check out their options on the exchange, which offers subsidies to families of four earning up to $90,000 a year.

“We’d be crazy not to,” said Kris Oehlerts, 48.

But they are leery of what the new coverage rules imply and will check their options carefully. The new health law opens up coverage regardless of pre-existing health conditions and narrows the span of risk to make coverage cheaper for people who otherwise would be costly customers or uninsurable. The law depends on new money from healthy people joining the system as a way to make coverage cheaper for others.

Gregg Oehlerts said he would consider his options as a business owner and would know a lot more a year from now. The first enrollment period runs six months through the end of March, but another follows late next year for those wanting coverage through the exchange for 2015.

“It’s going to cost a lot of money,” he said of the system. “It’ll work for some, but it’s going to add to our national debt.”

South Dakota consumers buying on the exchange will be customers of one of three carriers — Sanford, DakotaCare and Avera — which offer 35 different plans. Consumers also might continue buying from carriers that are not on the exchange and still satisfy the law’s requirements. But the exchange is the only place consumers will find tax subsidies available to cut the cost of premiums.

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Access to the new marketplace, at healthcare.gov, was down temporarily Tuesday.

“We had one staff member call the help center. She was on hold 35 minutes, then was told it wasn’t working,” said Melissa Klemann, assistant director of the South Dakota Division of Insurance in Pierre.

The federal website was working again later in the day.

The state is running a companion website, at federalhealthreform.sd.gov, but it is educational only. It provides a link to the federal site at healthcare.gov, which is where consumers must go if they wish to enroll online.

Those who do not want to use a computer may enroll by phone or on paper. A toll-free line at 800-318-2596 is one place to start. Another is any of several agencies across the state, where someone can arrange an interview with a specialist.

The downtown branch of the Siouxland Libraries in Sioux Falls will host an information table 1 to 6 p.m. Friday with representatives of Falls Community Health and Interlakes Community Action Partnership. Other sessions may follow at other branches, said Heather Stephenson, information services librarian.

Library users also are able to use computers at the various branches to enroll on the insurance exchange.

The Centers for Medicare and Medicaid Services, an agency of the federal government, is running the website from Maryland. It has information for 36 states, including South Dakota, that have chosen to have the federal government manage their insurance marketplace. Other states are running their own exchanges.

Mike Fierberg, a spokesman for the CMS in Denver, said he did not know why the website was down temporarily but said it had nothing to do with the shutdown of the federal government also occurring Tuesday because of the budget impasse in Washington.

Essential services remain in place, including those implementing the insurance marketplace.

“They are proceeding ... and they are open for business,” Fierberg said.

The first day of the insurance exchange included a public protest of government’s expanding role in health care. Emmett Reistroffer, 23, dressed in a mask to mimic President Obama, walked from Fawick Park toward Carnegie Town Hall, as Kim Johnson walked alongside calling out to motorists on 10th Street. Johnson said their main concern was rallying support for a patient choice initiative for the November 2014 ballot in South Dakota.

“More government and more bureaucrats don’t make it more affordable,” Reistroffer said.